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The history of medicine is intimately linked with the history of war. Written history, from ancient Egypt to the Iraq War, clearly demonstrates that revolutions in surgical care have taken place in parallel with the development of weapons and armor on the battlefield. Hippocrates, an ancient Greek physician, emphasized that “War is the only appropriate school for surgeons.” [1] However, the history of spine surgery in battle fields began even earlier than the era of Hippocrates. In an Egyptian papyrus from 1700 BC, we can find explanations of vertebral fracture and dislocation, as well as descriptions of military surgery [2].

Regretfully, humans seem to have an instinct to romanticize war. Because, compared to modern weapons of mass destruction, the power of weapons in the medieval period was limited to the number of people on the battlefield. Medieval knights, cavalrymen, and samurai are sometimes fantasized by ordinary people to have been romantic vagabonds or warriors. At that time, warrior’s thoracic and lumbar spines were well protected by body armor, but the cervical spine was often vulnerable [3]. Homer’s epic poem Iliad contains a vivid description of Achilles breaking the cervical spine of Trojan soldiers with his sword. This romanticized style of warfare, of which humans so often dream, became a nightmare in the Industrial Revolution. The Industrial Revolution was a time of great change for Europe and the rest of the world. No longer was the main mode of production in the hands of the family and professional craftsmen; instead, the balance shifted to favor factory owners and cheap labor. Mass production of weapons changed how wars were fought and increased the lethality of combat [4].

From the late 19th to the 20th century, Asian countries were indeed battlefields. From west to east and south to north, Asians from all countries were sacrificed in the name of imperialism, communism, nationalism, and capitalism. Ironically, all of these “isms” were created by human intellect and imagination, but resulted in the slaughter of untold millions of human beings (about 17 million people died in World War I and 60 million people died in World War II). People in Asian countries suffered from long periods of pain and desperation; however, with the development of medical and scientific knowledge, especially the discovery of antibiotics and blood replacement, many soldiers on the battlefield could survive their initial spinal injuries by more aggressive and invasive spine surgical procedures. Also, both World War provided opportunity for building formal and strong neurosurgery training program composed of cadaver dissection, lecture with clinical training. With this development of surgical training and principles in spine trauma surgery, immediate early surgical intervention was recommended to all soldiers with spinal cord injuries undergo to correct deformities or decompress the spinal cord [5].

Although both the Korean War and Vietnam War were disasters for the Korean and Vietnamese people, there were huge advancements in spine care during these wars. In conjunction with the construction of fixed military hospitals with modern operational capabilities, the new use of helicopters for evacuating injured soldiers from the battlefield further enhanced the possibility of military spinal surgery. For the first time, military spinal surgery similar to what is done in private hospitals could be performed in an appropriate environment. In the Korean War, neurosurgeons recommended that all soldiers with penetrating injuries of the cervical spine undergo laminectomy [4].

Despite the remarkable developments in spine surgery that have been achieved throughout a long and cruel history of war, the dark and painful memories of war make it difficult to create harmonious and peaceful relationships among the peoples of the world. A surprising fact is that the Korean War broke out in 1950, but is still not ended in 2018. Military tensions in the north and south continued both during the 3-year period of active war from 1950 to 1952 and the subsequent cold war period after that (1952–present). People living on each side of the border between the north and south did not have the opportunity to meet and understand each other. Correspondingly, other nations have no knowledge of how spine medicine is practiced in the Democratic People’s Republic of Korea (DPRK).

The society of the DPRK has become better known to the world through the recent South-North Korea and US-North Korea summit talks, and some novel aspects of spine medicine in the DPRK have come to light. The objective of Neurospine is to promote harmony in a way that is conducive to the academic development of spine doctors throughout the world. In order to accomplish this goal, we at Neurospine will open our arms and welcome academic contributions from the DPRK. In this issue of Neurospine, we are publishing a special invited paper (written by Dr. Kee B. Park et al.) introducing spine medicine as it is practiced in the DPRK. Through this paper, we can catch a glimpse of the history and current status of the spine care system in the DPRK. In the future, Neurospine will actively continue to publish papers on spine medicine from the DPRK, and will play a role as a gateway and collaborative platform to further mutual understanding. Thus, the authors and editors of Neurospine will be able to exchange academic knowledge with our forgotten friends in the DPRK.

After nearly 70 years, we have finally closed to the end of the Korean War. As important opinion leaders in each of our countries, Neurospine’s authors and editors would contribute to harmony among Asian nations and strive towards building peace and mutual understanding.

REFERENCES

1. Filler AG. A historical hypothesis of the first recorded neurosurgical operation: Isis, Osiris, Thoth, and the origin of the djed cross. Neurosurg Focus 2007;23:E6.